Providing primary care to an aging adult with Alzheimer's disease or dementia can be an emotionally and physically taxing responsibility. Adult daycare services may be an effective way to alleviate this burden. The literature review here provides a preliminary consideration of the uses, benefits and community-based options related to adult day care and dementia.
Alzheimer's
Adult Daycare for Patients with Alzheimer's Disease
Barriers to Daycare Utilization:
Fortinsky, Richard H., Kulldorff, Martin, Kleppinger, Alison, and Kenyon-Pesce, Lisa. (2009). Dementia care consultation for family caregivers: Collaborative model linking an Alzheimer's association chapter with primary care physicians. Aging & Mental Health, 13(2), 162-170.
The study by Fortinsky et al. (2009) discusses some of the obstacles standing between family caregivers and the admission of their patients to daycare nursing communities. The purpose of the research is to evaluate strategies that might improve the willingness of family caregivers to work with these community services. In a consultation with 84 family caregivers, the study aims to determine what strategies might raise confidence in the capabilities of such services. Additionally, the study seeks to evaluate the responses of primary caregivers to the outcomes produced by this type of intervention. A third objective of the study would be to determine how successfully caregivers and voluntary community service providers are able to collaborate in the given intervention environment. According to the study, "the dementia care consultation intervention showed favorable effects on nursing home admission and on caregiver outcomes among intervention group caregivers more satisfied with the intervention, but there are important barriers to sustaining this collaboration between primary care physicians and a voluntary sector organization such as an Alzheimer's association chapter." (p. 162)
This contributes a clear understanding, in the present research, of the paths to overcoming barriers in use of such daycare services.
Hamilton, Edith M., Braun, Jean W., Kerber, Paul, Thurlow, Christine, and Schwieterman, Irma. (1996). Factors associated with family caregivers' choice not to use services. American Journal of Alzheimer's Disease and Other Dementias, 11(4), 29-38.
The study by Hamilton et al. (1996) addresses what might be considered a control group in a research discussion concerning patients with dementia and daycare services. Here, an evaluation is given on the reasons offered by primary caregivers for choosing not to utilize such services. In a discussion on the implications of the burden placed on primary caregivers in facilitating the needs of aging family members with dementia or Alzheimer's, this forms an important part of our understanding. Specifically, the study surveys 70 respondents among primary caregivers who have been referred to but declined to employee such assistive services.
It finds that among the major reasons that individual caregivers have declined to employ such services, the major focus is on a negative impression of the competence represented in such treatment contexts. According to the study, "Personal competence, measured as perception of caregiving mastery, emerged as a significant factor in service nonuse. Caregiver gender and daily hours of caregiving, an environmental press factor combined with perception of mastery to most often correctly classify respondents' high and low adaptation." (p. 29) The resolution of this study is an important one within the context of the present research as well. Here, researchers resolve that it is necessary to focus on improving quality, training and competence among adult daycare service caregivers.
Benefits of Daycare Utilization:
Mossello, Enrico, Caleri, Veronica, Razzi, Elena, Di Ban, Mauro, Cantini, Claudia, tonon, Elisabetta et al. (2008). Day care for older dementia patients: Favorable effects on behavioral and psychological symptoms and caregiver stress. International Journal of Geriatric Psychiatry, 23(10), 1066-1072.
The study by Messello et al. (2008) offers a high level assessment of the benefits of daycare utilization for adults with dementia. The study focuses specifically on a comparative assessment of subjects with dementia admitted for daycare (DC) and those prescribed homecare (HC). The study was engaged across a 2-month period during which 30 patients in each of the prescribed groups was observed for a range of characteristics. The included characteristics would be cognitive and functional status, behavioral and psychological symptoms and psychotropic drug use. The specific priority for our research is the finding concerning behavioral and psychological symptoms. However, also of value to the present study is the reference made in the research to the burden placed on the primary caregiver. This is because a discussion of the benefits of daycare must include, in addition to a discussion on its benefits to the patient, its benefits to the caregiver. According to the findings for the study in question, "A 2-month period of DC assistance is effective in reducing behavioral and psychological symptoms of dementia patients and in alleviating caregivers' burden." (p. 1066) This is a promising finding, particularly as a formative assertion in deriving an actionable research hypothesis.
Vreugdenhil, Anthea, Cannell, John, Davies, Andrew, and Razay, George. (2011). A community-based exercise programme to improve functional ability in people with Alzheimer's disease: A randomized controlled trial. Scandinavian Journal of Caring Sciences, 26(1), 12-19.
When evaluating an ideal daycare setting to benefit an individual suffering from an advancing Alzheimer's or dementia-related condition, it is important to consider so of the most highly recommended interventions for such subjects. An important benefit of adult daycare utilization is the higher degree of direct physical engagement that it affords the patient. This concept is articulated in the research by Vreugdenhil et al. (2011), which considers the importance of maintaining a steady exercise regimen for a given patient. According to the article, "at 4-months follow-up, patients who exercised, compared with controls, had improved cognition (increased Mini Mental State Examination scores by 2.6 points, p < 0.001), better mobility (2.9 seconds faster on Timed Up and Go, p = 0.004) and increased Instrumental Activities of Daily Living scores by 1.6 (p = 0.007). This study suggests that participation in a community-based exercise programme can improve cognitive and physical function and independence in ADL in people with Alzheimer's disease." (p. 12)
The article also points out that the challenge of facilitating this level of exercise as a primary caregiver can be difficult. The text notes that with individuals living longer and dementia consequently becoming more commonplace, many family-member caregivers require the critical assistance that'd only possible through adult daycare. The evidence produced by this article indicates that among its many benefits, the ability of staff at a given facility to accommodate the need for exercise can substantially improve the patient's faculties, slow down the pace of mental decline and, consequently, even lead to a lengthening of the patient's life.
The Use of Community Service:
Weissert, W.G.; Elston, J.M.; Bolda, E.J.; Cready, C.M.; Zelman, W.N.; Sloane, P.D.; Kalsbeek, W.D.; Mutran, E.; Rice, T.H. & Koch, G.G. (1989). Models of Adult Day Care: Findings From a National Survey. The Gerontologist, 29(5), 640-649.
The article by Weissert et al. give consideration to the array of models for adult caregiving that are currently employed. This consideration includes an elaboration on the challenges that are specific to the community care model. Most specifically, the article discusses some of the practical demands that particularly impact Alzheimer's patients and, in doing so, contributes several concepts to our discussion. Namely, the article notes that community adult day-care facilities are often most limited in their "services, staffing, costs and other program features." (p. 423) This may prevent community care centers from being the most optimal outlet for care of patients with a condition that does require constant and steady monitoring.
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